Can lymphedema cause redness?

Lymphedema and Skin Redness

Yes, lymphedema can definitely cause redness of the skin, which is a common clinical manifestation of this condition and can indicate inflammation or infection requiring prompt attention. 1

Pathophysiology of Skin Redness in Lymphedema

Lymphedema creates conditions that promote skin changes including redness through several mechanisms:

• Chronic fluid accumulation in the interstitial spaces creates increased tissue pressure 1
• Compromised skin barrier function due to stretching and thinning of the skin
• Impaired local immune function due to disrupted lymphatic drainage 1, 2

The skin manifestations of lymphedema typically include:

• Rapidly spreading areas of edema, redness, and heat
• Skin surface may resemble an orange peel (peau d'orange) due to superficial cutaneous edema surrounding hair follicles 3
• Vesicles, bullae, and cutaneous hemorrhage may develop on the inflamed skin 3, 1

Clinical Significance of Redness in Lymphedema

When redness appears in a lymphedematous limb, it requires careful assessment as it may indicate:

1. Cellulitis/Erysipelas - A serious infection requiring immediate treatment

   • Manifested by rapidly spreading areas of edema, redness, and heat
   • May be accompanied by lymphangitis and inflammation of regional lymph nodes 3
   • Can progress to systemic infection and septic shock if untreated 2

2. Non-infectious inflammation - Due to the chronic inflammatory state of lymphedematous tissue

Risk Factors for Cellulitis in Lymphedema

Patients with lymphedema have significantly increased risk of cellulitis:

• 37.6% of lymphedema patients experience at least one cellulitis episode 4
• 23.3% develop recurrent cellulitis 4

Specific risk factors include:

• Delayed treatment of lymphedema (longer interval from onset to specialized care) 4
• Prior lymph node excision (for secondary lymphedema) 4
• Higher BMI (for primary lower limb lymphedema) 4
• Male sex (for primary lower limb lymphedema) 4

Management Approach

When redness appears in a lymphedematous limb:

1. Urgent assessment to differentiate between:

   • Cellulitis/erysipelas (infection)
   • Non-infectious inflammation

2. If infection is suspected:

   • Prompt antibiotic treatment is essential
   • First-line options include penicillinase-resistant penicillin or first-generation cephalosporin 1
   • For penicillin allergies: clindamycin or vancomycin 1
   • Monitor closely for systemic symptoms (fever, tachycardia, confusion, hypotension) 3

3. For recurrent infections:

   • Consider prophylactic antibiotics
   • Options include monthly intramuscular benzathine penicillin injections or oral therapy with twice-daily doses of erythromycin or penicillin V 1

Prevention of Skin Complications

To prevent redness and other skin complications:

• Meticulous skin care:

  • Gentle cleansing with pH5 neutral bath and shower formulations
  • Patting skin dry rather than rubbing
  • Applying hypoallergenic moisturizing creams or emollients once daily 1

• Compression therapy:

  • Essential component of lymphedema management
  • Helps reduce fluid accumulation and improve lymphatic flow 1

• Regular monitoring:

  • Assessment of skin condition to detect early signs of breakdown or infection
  • Patient education about recognizing early signs of infection 1

Important Cautions

• Redness with systemic symptoms requires immediate medical attention as it may indicate serious infection that can progress rapidly 2
• Untreated cellulitis in lymphedematous extremities can lead to septic shock and potentially be fatal 2
• Differential diagnosis should consider other causes of skin redness such as contact dermatitis, bullous pemphigoid, or medication reactions 1

Lymphedema is a chronic condition requiring ongoing management to prevent complications like infection and skin breakdown. Prompt recognition and treatment of redness is essential to prevent serious complications and maintain quality of life.